Dealing out blame for hospital closings

When hospitals close, it is not just a matter of moving patients, or shifting ambulance routes, or even improving the finances of the other hospitals. It is a significant and permanent loss for our communities, for nurses and healthcare workers, area residents, and patients. The impact can be devastating on access to needed healthcare, on unemployment rates and on the profits of family and local businesses.

Yet the decisions that lead to a hospital closing rest not in the hands of those most affected, but in the hands of self-selecting hospital board members, bondholders and creditors, and ultimately state agencies - even while the causes of these crises can also be traced to poor decision making by hospital boards, and "too-little, too-late" intervention by our state agencies.

Since Pascack Valley Hospital in Bergen County closed its doors, stories abound of long ambulance rides, ambulances diverted from hospital to hospital, long waits for hospital beds, and even longer waits in our remaining emergency rooms. For the patients and their families, and for the nurses and health care workers trying to take care of these patients, having "too many beds" doesn't seem to be the real problem.

In Essex and Passaic counties, where experts also claim to be "over-bedded," area residents are similarly fearful as plans advance to close more hospitals - two out of three local Catholic hospitals in Essex County, and one of two remaining hospitals in Paterson. In that city, we now have only one hospital remaining, and no hospital that will provide women's reproductive services. How did we allow this to happen? And, more important, how will we stop the cycle of hospital failures?

While a recently released report of the Governor's Commission on Rationalizing Healthcare Resources did review a fairly comprehensive set of problems underlying our health care system, unfortunately, many of the news articles and editorials focused on the issue of too many beds in northern New Jersey as the cause of our health care crisis.

Is the issue too many beds or too little oversight and accountability for how our healthcare dollars are being spent by private hospital boards of directors?

While northern New Jersey does have more hospitals in closer proximity to each other, we also suffer from older infrastructures for our hospitals, more competition from surgery centers, and a complete lack of coordination and cooperation among hospitals for shared services and therefore improved efficiencies. Hospitals compete with each other for services and amenities that they think will bring in more money, but often these plans backfire.

No state agency has had the will or authority to step in as our hospitals incurred significant and often unwise debt in order to launch new services, build or expand. We have had a "hands-off" state policy towards hospital finances and patient care, even though when poor decisions are made, our communities pay the ultimate price.

Prior to the commission's report, our unions testified on the need for transparency and accountability to the community by hospital boards and for oversight and earlier intervention by state agencies into hospital debt and financial practices. We argued for establishment of standards and "best practices" for hospitals to receive bonding through our state agencies, incurring debt that in reality, we all must re-pay, through taxes, increased health care costs and the ultimate price of bankruptcy and hospital closures.

Too often, it is our experience that members of hospital boards often conduct business with their hospital, posing a conflict for decision-making that can put the interests of their private business before the interests of the community. The commission's report called for adoption of best practices and training for hospital boards, rightfully calling current boards "self-perpetuating."

The report notes that one hospital's closure automatically helps the finances of other area hospitals. Without a long-range planning process with the goal of maintaining needed services, facilitating shared services among area hospitals, and developing alternative uses for hospitals in danger of closing, a hospital's closure will not automatically serve other area hospitals, and certainly will not serve patients, workers or surrounding communities. This is abundantly clear to those of us living and working in Bergen, Passaic, Hudson and Essex counties.

The report groups hospitals together in geographic areas, and determines excess bed capacity based on those areas without adequate consideration of insurance restrictions, physician patterns and transportation limitations. We need a regional planning process for coordinating and delivering healthcare services grounded in the realities of how and where our residents obtain their health care. Without that process, when a hospital which delivers 1000 babies a year closes in the Ironbound section of Newark, who can say what other hospitals are close enough and ready to take over that service? When a hospital in Paterson closes that provides reproductive services to women, who makes sure that women still have access to essential care?

In fact, the state can and must establish a regional system that requires area hospitals to work together to develop plans for shared services, to allocate resources in a cooperative manner in order to best serve our communities and to assure that our patient care dollars are wisely spent and that healthcare will be there, nearby, when we need it.